perceived opposition to the abortion from partners, family, and/or friends

lack of perceived social support from others

various personality traits (e.g., low self-esteem, a pessimistic outlook, low-perceived control over life)

a history of mental health problems prior to the pregnancy

feelings of stigma

perceived need for secrecy

exposure to antiabortion picketing

use of avoidance and denial coping strategies

Feelings of commitment to the pregnancy

ambivalence about the abortion decision

low perceived ability to cope with the abortion

history of prior abortion

late term abortion

By parsing of the APA summary conclusion that "adult women who have an unplanned pregnancy the relative risk of mental health problems is no greater if they have a single elective first-trimester abortion than if they deliver that pregnancy," it also appears that the APA is identifying the following as risk factors

Most Complete List of Risk Factors for Negative Psychological Reactions to Abortion

The lists of risk factors chosen by the APA and the National Abortion Federation is based on a subjective judgments and do not include a complete list of risk factors that have been statistically validated in peer reviewed medical literature.

Four Types of Women

According to Philip Ney, from a clinical perspective there are four groups of women having abortion:

Tough and committed. Those who insist that abortion is a woman’s right.

Vulnerable. Those who are basically unstable who are pushed into a definable mental illness by the trauma of abortion.

Sensitive. Those who are reasonably mentally healthy but because of their sensitivities, they are deeply hurt by having an abortion and develop psychiatric symptoms which a researcher defines as an illness.

Resilient. Those who choose abortion as the least worst alternative and don’t appear to be affected for years until poor health or stressful circumstance undermine their ego defenses.

Emotional harm from abortion is more likely when one or more of the following risk factors are present: prior history of mental illness; immature interpersonal relationships; unstable, conflicted relationship with one's partner; history of negative relationship with one's mother; ambivalence regarding abortion; religious and cultural background hostile to abortion; single status especially if no born children; adolescent; second-trimester abortion; abortion for genetic reason; pressure and coercion to abort; prior abortion; prior children; maternal orientation.

Certain categories of women are much more likely to have post-abortion problems sometimes many months or years later. These include: being forced or coerced into abortion; women who place great emphasis on future fertility plans; women with pre- existing psychiatric problems; women suffering from unresolved grief reactions or women with a history of sexual abuse, including incest, molestation or rape.

This study measured short- term outcomes of anxiety, depression, anger, guilt and shame following abortion. The authors concluded that women who are most vulnerable to difficulty are those who are single and nulliparous, those with previous history of serious emotional problems, conflicted relationships to lovers, past negative relationships to mother, ambivalence toward abortion or negative religious or cultural attitudes about abortion.

"The Decision-Making Process and the Outcome of Therapeutic Abortion, C," Friedman, R. Greenspan and F. Mittleman, American Journal of Psychiatry 131(12): 1332-1337, December 1974.

There is high risk for post-abortion psychiatric illness when there is (1) Strong ambivalence; (2) Coercion; (3) Medical indication; (4) Concomitant psychiatric illness and (5) A woman feeling the decision was not her own.

Risk Factors for Multiple Abortions

Background: Although repeat induced abortion is common, data concerning characteristics of women undergoing this procedure are lacking. We conducted this study to identify the characteristics, including history of physical abuse by a male partner and history of sexual abuse, of women who present for repeat induced abortion.

Methods: We surveyed a consecutive series of women presenting for initial or repeat pregnancy termination to a regional provider of abortion services for a wide geographic area in southwestern Ontario between August 1998 and May 1999. Self-reported demographic characteristics, attitudes and practices regarding contraception, history of relationship violence, history of sexual abuse or coercion, and related variables were assessed as potential correlates of repeat induced abortion. We used χ2 tests for linear trend to examine characteristics of women undergoing a first, second, or third or subsequent abortion. We analyzed significant correlates of repeat abortion using stepwise multivariate multinomial logistic regression to identify factors uniquely associated with repeat abortion.

Interpretation: Among other factors, a history of physical or sexual abuse was associated with repeat induced abortion. Presentation for repeat abortion may be an important indication to screen for a current or past history of relationship violence and sexual abuse.

Screening for Coercion

"Women of all ages experience intimate partner violence, but it is most prevalent among reproductive-age women," Dr. Maureen Phipps, chair of the college's Committee on Health Care for Underserved Women, said in the news release. "We have a prime opportunity to identify and help women who are being abused by incorporating this screening into our routine office visits with each and every patient."

Clearly, this recommendation should extend to abortion providers as there is ample evidence that pregnant women are more likely to face coercion to have an unwanted abortion which can escalate to acts of violence.

"Women seeking abortions may be at higher risk of prior untreated mental health disorders and the abortion care setting may be an important intervention point for mental health screening and referrals."

"Women with likely diagnoses of both PTSD and a major depressive episode are at a 4-fold increased risk of preterm birth; this risk is greater than, and independent of, antidepressant and benzodiazepine use and is not simply a function of mood or anxiety symptoms."

"Certain groups are especially at risk from adverse psychological sequelae; these include those with a past psychiatric history, younger women, those with poor social support, the multiparous, and those belonging to sociocultural groups antagonistic to abortion. ... A better understanding of the nature of the risk factors would enable clinicians to identify vulnerable women for whom some form of psychological intervention might be beneficial." Women who choose abortion are not amenable to endless questions on how they feel, are less likely to return for follow-up, and baseline assessments before they become pregnant are impossible.